[Syringomyelia and intra-rachidian fluids. IV. Syringomyelia to the naked eye].
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Adult↗
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[Syringomyelia and intra-rachidian fluids. XII. Actual surgery syringomyelia].
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Adolescent↗
[Syringomyelia and intra-rachidian fluids. II. Slowness of syringomyelia].
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Adult↗
[Syringomyelia and intra-rachidian fluids. I. Syringomyelia: 2 conceptions].
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Adult↗
Scoliosis associated with syringomyelia presenting in children.
The clinical presentations and radiological features of scoliosis accompanying syringomyelia were analyzed in 14 cases of syringomyelia associated with a in 14 cases of syringomyelia associated with a Chiari malformation in children. Scoliosis was the initial symptom in 11 out of 16 patients (64%) with syringomyelia and present in 14 (88%) at the initial examination. The scoliosis associated with syringomyelia was characterized by a higher incidence of a single curve (6 cases, 43%) and convexity to the left (7 cases, 50%) than seen in idiopathic scoliosis. The syrinx was shifted to the convex side of scoliosis on the axial section at the middle or lower thoracic level in patients with a single curve, and at the cervical or upper thoracic level in patients with a double curve. The authors think that the scoliosis develops in children as a result of damage done to the anterior horn, which innervates the muscles of the trunk, by an asymmetrically expanded syrinx.
Arnold-Chiari Malformation↗
Pathogenesis and treatment of delayed post-traumatic syringomyelia.
The role of trauma in the pathogenesis of syringomyelia has been known for a long time. Repeated microtraumata have been considered to play a role in triggering the classical syringomyelia on the basis of a congenital predisposition. It has been proven that post-traumatic arachnoiditis can cause cavitation in the spinal cord and probably syringomyelia stricto sensu as well. The delayed appearance of syringomyelia after a severe single spinal trauma resulting in contusion of the spinal cord without the complication of arachnoiditis is a more recent issue, but is now well-known. Delayed syringomyelia after a minor single spinal trauma, with at first complete recovery, is extremely rare, and is probably often disregarded as a diagnosis. Having studied such a case, with complete neuroradiological work-up, we want to draw attention to the pathogenetic aspects and the possibilities for treatment, of which the syringoperitoneal shunt seems to be the most efficient one.
Adult↗
Terminal ventriculostomy in syringomyelia.
The authors report their experiences with two patients suffering from syringomyelia on whom terminal ventriculostomies were carried out. The good results which can be obtained if the patient is in a relatively good neurological condition are pointed out. The principle of terminal ventriculostomy is based on the assumption that syringomyelia is hydromyelia that has become symptomatic; with this in mind, it seems reasonable to relieve the patient's symptoms by draining the distended central canal at the lowest possible level. The father of the operation is Dr. Gardner, who has thoroughly studied syringomyelia, and proved that syringomyelia is not only an active hydromyelia but, that a "non-communicating" syringomyelia is a non-existent entity (1976, 1977).
Adult↗
Gardner's hydrodynamic theory of syringomyelia revisited.
Several theories have been put forth to explain the pathogenesis of syringomyelia, the formation of longitudinal, fluid-filled cavities within the spinal cord. Chief among them is Gardner's hydrodynamic theory, widely accepted for more than two decades. Gardner attributed the genesis of syringomyelia to craniospinal pressure differentials in the setting of fourth ventricular outlet obstruction; these differentials favor cerebrospinal fluid shifts from the fourth ventricle of the brain through the central canal of the spinal cord. Gardner's theory has been questioned, and several alternative theories of syringomyelia have been proposed. Physiological data and new information from magnetic resonance imaging support many of Gardner's concepts; however, a more comprehensive elucidation of the pathophysiologic mechanisms of syringomyelia requires incorporating facets of the other theories. We propose a unified theory of the pathogenesis of syringomyelia based on recent experience with magnetic resonance imaging, and on elements of other current theories.
Cerebrospinal Fluid Pressure↗
[The pattern of neurological deterioration and the mechanism of neurological deficit in syringomyelia].
Sixty-five cases of syringomyelia were evaluated. The cases were classified into two groups: group 1 (56 cases) was patients who presented with hind-brain related syringomyelia and group 2 (9 cases) was patients who presented with primary spinal syringomyelia. Group 1 was further divided into two subgroups, group 1a and group 1b: group 1a (46 cases) consisted of patients with hind-brain related syringomyelia without basal arachnoiditis and group 1b (10 cases) consisted of patients with hind-brain related syringomyelia with basal arachnoiditis. The most common initial symptom of group 1a patients was abnormal motor function of an upper limb (14 cases), followed by pain in an upper limb (12 cases), and dissociated sensory loss (10 cases). In group 1b, motor symptoms of an upper limb were also the most common initial symptom, again followed by pain in an upper limb. Paraplegia was the most common initial symptom in group 2. About 80% of patients in groups 1a and 1b had both sensory and motor deficits at the time of examination and the majority of group 1b patients also had brain stem signs and/or pain. Brain stem signs were not commonly seen in group 1a patients, however. The neurologic deficits of group 1b patients were generally more severe than those of group 1a patients. Most group 2 patients also had sensory and motor deficits of both lower limbs. The progression of neurological deficits in groups 1a and 1b was classified into four stages.(ABSTRACT TRUNCATED AT 250 WORDS)
Adolescent↗
Difficult labour as a cause of communicating syringomyelia.
Although some causes of communicating syringomyelia are known most cases of the disease can only be described as idiopathic. The results of a questionnaire suggest a high incidence of difficult labour in the mothers of syringomyelia patients. A high proportion of patients had forceps deliveries, and a high proportion were the first born in their families. Because the validity of taking a birth history at the age of presentation (mean age 40 y, S.D. 14 for this sample) might be questioned, patients admitted with other disorders (mean age 40 y, S.D. 16) were used as a control group. These patients matched the syringomyelia patients in social class and place of birth. It seems likely that birth trauma may be a cause of tonsillar descent through the foramen magnum (ectopia) and of arachnoiditis; both conditions are often present. Once the tonsils become engaged in the foramen magnum, difference between the cranial and spinal pressure may, over the course of several years, cause the tonsils to descend further, thus leading to communicating syringomyelia. Over half these patients have a history of difficult labour and it is possible that birth injury may be a factor even where birth is regarded as normal.
Adult↗
Surgical management of syringomyelia: a five year experience in the era of magnetic resonance imaging.
We summarize our experience with 59 consecutive surgically managed cases of syringomyelia (SM) over a 5 year period. All cases had magnetic resonance imaging (MRI) preoperatively and postoperatively. Twenty-eight patients presented with SM and the adult Chiari (Chiari I) malformation (SM-ACM), 6 patients had post traumatic syrinxes, 14 patients had syrinxes associated with an intramedullary neoplasm, 3 patients had syringomyelia associated with spinal arachnoiditis and 8 patients had idiopathic syringomyelia. Holocord syrinxes were more often associated with SM-ACM, while focal syrinxes were associated with posttraumatic, spinal arachnoiditis and neoplastic conditions. In all cases with neoplasms the MRI revealed parenchymal intramedullary signal abnormalities in addition to the syrinx cavity. Posterior fossa decompression with obex plugging (the Gardner operation) was the procedure of choice for SM-ACM and for idiopathic holocord syringomyelia. Exploration and drainage of the syrinx with or without shunting was carried out mainly for focal syrinxes associated with trauma and neoplasm. Patients with SM-ACM responded well to posterior fossa decompression with satisfactory results in 24/28 patients. Idiopathic SM is probably a forme fruste of SM-ACM and when treated with the Gardner procedure showed good results in all 8 patients. Posttraumatic and neoplastic SM had the least predictable results with surgery. The disappearance of the syrinx on postoperative MRI correlated well with a good surgical outcome.
Adolescent↗
[Prevalence and features of the course of syringomyelia in the Samarkand region of the tuzbek SSR].
The paper is concerned with a clinico-statistical study of syringomyelia according to the data of neurological hospitals in the Samarkand region from 1931--1970. It was established that the portion of syringomyelia among other diseases of the nervous system is much lower (0.38%) than in other more northern regions of the country (3--7%). The author marks a significantly greater amount of patients among the city population rather than in the rural population (2/3) and a prevalence of non-natives over natives (more than 2/3). The development of syringomyelia is more milder, "benign", especially in the native population. Quite possibly this may be connected with the climatic-geographical and bio-geochemical traits of the Zarafshanskaya valley, which differs to a great extent from these indices of the territory between the Vyatka and Kama rivers where syringomyelia is frequently encountered.
Adult↗
[Quantitative analysis of cerebrospinal fluid dynamics in syringomyelia using cine MRI with pre-saturation].
Some reports show the qualitative analysis of cerebrospinal fluid (CSF) pulsation in the subarachnoid space and the syrinx using cine magnetic resonance imaging (MRI). However, few reports studied the quantitative analysis of CSF pulsation. We report here the results of quantitative analysis of CSF pulsation using the cine MRI with pre-saturation pulse. Using flow phantom, we calibrated the correlation between the true velocity and calculated velocity acquired from the movement of pre-saturated low signal. Three cases of syringomyelia with Chiari malformation, two cases of traumatic syringomyelia, and three normal volunteers were examined using this technique, and we could obtain time-velocity curves of CSF in both subarachnoid spaces and syrinx. Although obvious pulsation of CSF was observed in the syrinx of all Chiari malformations, no pulsation of CSF was observed in the syrinx of traumatic syringomyelia. CSF in the syrinx moves upward in the early systolic cardiac cycle, downward in the systolic cycle, and upward again in the diastolic cycle. Patterns of CSF pulsation in syrinx were similar to those in the subarachnoid space, but "phase" of these pulsations differed from case to case. These results suggest the close relationship between CSF pulsation in the syrinx and CSF obstruction at the cranio-vertebral junction. Dissociation of the "phase" of CSF pulsation in the syrinx and subarachnoid space may be significant in the analysis of the pathogenesis of syringomyelia.
Adult↗
[A surgical treatment method in syringomyelia].
The author provides pathogenetic evidence for surgical treatment of syringomyelia. Based on the experience gained with surgical treatment of syringomyelia, gives a critical assessment of the hydrodynamic theory of the formation of intraspinal cavities. Provides the data obtained during examination of 127 patients suffering from genuine syringomyelia with the aid of cystography and NMR tomography. The communicating and non-communicating disease pattern were established. The short- and long-term results of surgical treatment were elucidated in 109 patients operated on. It is assumed that derangement of hydrodynamics plays a definite part in the disease pathogenesis. The hydrodynamic alterations include not only circulatory disorders but also have the signs of general functional insufficiency of the CSF system. The surgical treatment method is aimed at the correction of the hydrodynamic alterations, being one of the constituent parts in the whole complex of treatment measures for syringomyelia.
Adolescent↗
Paraplegia, syringomyelia tarda and neuropathic arthrosis of the shoulder: a triad.
A casually related triad of syringomyelia tarda, postparaplegia with secondary neuropathic arthrosis of the shoulder has been presented. The development of neuropathic arthrosis of the shoulder has been presented. The development of neuropathic arthrosis of the shoulder in 2 of our paraplegic patients prompted us to look for a correlation and/or a common etiology. Paraplegia secondary to spinal cord injury could be causative or at least an associated factor in a delayed proximal syringomyelia. It is the syringomyelia which can lead to the neuropathic arthrosis in the upper extremity, mainly, in the shoulder. There is an interesting pathological association of paraplegia and syringomyelia with neuropathic arthrosis. Earlier awareness of any neurological changes in the upper extremity of the paraplegic patient could point to recognition of syringomyelic process and portend a tendency toward neuropathic arthrosis of the shoulder. This would require a high index of suspicion, and subsequently a preventative, protective orthopedic approach to minimize the usual functional deformity that occurs when this neuropathy involves the shoulder.
Adult↗
Anterior cervical arachnoid cyst simulating syringomyelia: a case with preceding posterior arachnoid cysts.
An arachnoid cyst lying anterior to the cervical cord at level C6-7 was found in a 28-year-old woman believed to have syringomyelia. This diagnosis was based both on previous findings at laminectomy and on computerized tomography. The diagnosis of arachnoid cyst was suspected because of clinical features atypical for classical syringomyelia and a history of arachnoid cysts found during childhood. Air myelography demonstrated an extramedullary intradural mass anteriorly that proved to be an arachnoid cyst. Drainage and subtotal resection resulted in marked clinical improvement. This case illustrates the need for reevaluation when a patient with "known" syringomyelia presents an atypical clinical picture. Anterior cervical arachnoid cyst, which may accompany or succeed posterior arachnoid cysts, should be considered.
Adolescent↗
Familial syringomyelia: a report of four cases.
The clinical and neurological features of four siblings (2 male, 2 female) affected by syringomyelia are described. A fifth sister was affected by an acoustic neurinoma. Since neither parent showed signs of syringomyelia, this is considered to be a datum substantiating the dysembryogenetic theory of the syringomyelia syndrome.
Adult↗
Syringomyelia associated with post-meningitic spinal arachnoiditis due to Candida tropicalis.
A 63 year old man who suffered from syringomyelia related to post-meningitic spinal arachnoiditis caused by Candida tropicalis is reported. The clinical syndrome of syringomyelia developed gradually and a definite diagnosis was delayed for more than 10 years. The patient has partially recovered after surgical treatment. This form of fungal infection and its delayed neurological complication in the form of syringomyelia has not been reported previously, to our knowledge.
Arachnoiditis↗